-
Review ArticleMenstrual Hygiene, Management, and Waste Disposal:
Practicesand Challenges Faced by Girls/Women of Developing
Countries
Rajanbir Kaur,1 Kanwaljit Kaur,2 and Rajinder Kaur 1
1Department of Botanical and Environmental Sciences, Guru Nanak
Dev University, Amritsar, Punjab 143005, India2Govt. Polytechnic
College for Girls, Amritsar, India
Correspondence should be addressed to Rajinder Kaur;
[email protected]
Received 26 September 2017; Accepted 12 November 2017; Published
20 February 2018
Academic Editor: Mynepalli K. C. Sridhar
Copyright © 2018 Rajanbir Kaur et al. This is an open access
article distributed under the Creative Commons Attribution
License,which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly
cited.
Menstruation and menstrual practices still face many social,
cultural, and religious restrictions which are a big barrier in the
pathof menstrual hygiene management. In many parts of the country
especially in rural areas girls are not prepared and aware
aboutmenstruation so they face many difficulties and challenges at
home, schools, and work places. While reviewing literature, we
foundthat little, inaccurate, or incomplete knowledge about
menstruation is a great hindrance in the path of personal and
menstrualhygienemanagement. Girls and women have very less or no
knowledge about reproductive tract infections caused due to
ignoranceof personal hygiene during menstruation time. In rural
areas, women do not have access to sanitary products or they know
verylittle about the types and method of using them or are unable
to afford such products due to high cost. So, they mostly rely
onreusable cloth pads which they wash and use again. Needs and
requirements of the adolescent girls and women are ignored
despitethe fact that there are major developments in the area of
water and sanitation. Women manage menstruation differently when
theyare at home or outside; at homes, they dispose of menstrual
products in domestic wastes and in public toilets and they flush
themin the toilets without knowing the consequences of choking. So,
there should be a need to educate and make them aware about
theenvironmental pollution and health hazards associated with them.
Implementation ofmodern techniques like incineration can helpto
reduce the waste. Also, awareness should be created to emphasize
the use of reusable sanitary products or the natural
sanitaryproducts made from materials like banana fibre, bamboo
fibre, sea sponges, water hyacinth, and so on.
1. Introduction
According to World Health Organization, a person aged10–19 years
is considered as an adolescent [1]. The transitionperiod between
the childhood and adulthood is called ado-lescence which is marked
with the growth and developmentof the child. During this period,
physical, psychological,and biological development of the child
occurs [2]. It isrecognized as a special period in a girl’s life
cycle whichrequires special attention. Menarche is an important
biolog-ical milestone in a woman’s life as it marks the onset of
thereproductive phase of her life. The average age at menarcheis
mostly consistent across the populations, that is, between12 and 13
years of age [3, 4]. Unfortunately, due to lack ofknowledge on
menstruation preparedness and managementor due to shyness and
embarrassment the situation becomesworse for girls [5].
Menstruation is a natural process but it is
still a taboo in Indian society as it is considered unclean
anddirty [6].
Menstruation wastes are the wastes that are generated bya female
in her reproductive years.These wastes are producedduring
menstruation commonly known as menses, periods,or monthly bleeding
cycle [7]. The menstrual cycle hasthree phases, that is, follicular
phase (proliferative), ovulationphase, and luteal phase
(secretory).Menstruation is regulatedby hormones; in this process,
endometrium, lining of uterus,gradually thickens and sheds off and
causes bleeding thatnormally last for 3–5 days and occasionally up
to 7 days.Menstruation sheds two-thirds of the endometrial
lining.In addition to blood, menstrual fluid contains mucus
andvaginal secretions [8].Themenstrual flow varies from femaleto
female andmay be more or less at the beginning of mensesor may
change throughout the cycle. The color of the men-strual fluid
varies between red, bright red, and dark brown to
HindawiJournal of Environmental and Public HealthVolume 2018,
Article ID 1730964, 9 pageshttps://doi.org/10.1155/2018/1730964
http://orcid.org/0000-0002-7857-9919https://doi.org/10.1155/2018/1730964
-
2 Journal of Environmental and Public Health
black.Menstrual fluidmay ormay not have unpleasant
odourespecially when it comes in contact with air. Menstrual flowor
duration also changes before menopause or during gynae-cological
cancers. Under conditions of hormonal imbalance,fibroids, polyps,
and endometriosis menstrual flow increaseand excessive loss of
blood through menstruation can lead toanaemia.
Women have developed their own personal strategiesto handle this
period of time. Globally, these strategiesvary greatly due to the
personal preferences, availability ofresources, economic status,
cultural traditions and beliefs,education status, and knowledge
about menstruation. Prac-tices related to menstruation hygiene are
of major concernas it has a health impact; if neglected, it leads
to toxic shocksyndrome, reproductive tract infections (RTI), and
othervaginal diseases [9–11]. Poor genital hygiene negatively
affectsadolescents’ health. Most girls are unaware and
unpreparedfor menarche as they are not informed or ill-informed
aboutmenstruation [12]. The main objective of this review was
tosummarize the concern and possible methods of menstrualwaste
management in low-income countries. The reviewarticle was aimed at
understanding the menstrual practices,product design, demands, and
disposal strategies. It includesboth a summary of the existing
menstrual hygiene needs andmanagement and also an analysis of the
current knowledgein the fields of public health, water and
sanitation, and solidwaste management.
2. Cultural Beliefs and Restrictionsduring Menstruation
Menstrual hygiene practices were affected by cultural
norms,parental influence, personal preferences, economic status,and
socioeconomic pressures. Menstrual beliefs refer tomisconceptions
and attitudes towards menstruation withina given culture or
religion. Menstrual beliefs, knowledge,and practices were all
interrelated to the menstrual hygienemanagement [13, 14]. By
reviewing literature and articlespublished in journals and reports
available on the Internet wefound many cultural and religious
beliefs followed by peopleregarding menstruation. These norms were
the barriers inthe path of good menstrual hygiene practices. Many
womenexperiencing restrictions on cooking, work activities,
sexualintercourse, bathing, worshipping, and eating certain
foods[15]. These restrictions were due to the overall perception
ofthe people regarding menstruation as they consider it dirtyand
polluting [16].
In some parts of the country there were restrictions onbathing
and a taboo against burial of bloodied menstrualcloth. Cloths
should first be washed and then buried orreused.Washing and drying
thought to be done secretly or ina hidden corner so that it cannot
be seen by others [17]. It wasalso believed that menstrual fluids
may be misused for blackmagic, sowomen shouldwash
thewrapper/clothwore duringmenses only at night when others were
asleep [18]. Menstrualflow was seen as dirty, polluting, and
shameful, so womenhide menstrual cloths for fear of being cursed.
In similarfindings, it was believed that menstrual waste was linked
towitchcraft and danger, so it must be buried unless witches
go after human blood and find the menstrual wrapper/clothand
destroy the women by causing infertility [13]. From allthese
beliefs, it was clear that education plays a key rolein
menstruation hygiene management. By educating bothmen and women
regarding menstruation, we can overcomethese false beliefs and
taboos. Due to cultural expectationsand restrictions many girls
were not adequately informedabout the realities of menstruation. As
a result, they feelsubnormal, diseased, or traumatized [19].
Unprepared girlswere frightened, confused, and feel embarrassed
bymenarchelikely to develop negative attitudes towards
menstruation[20]. Even touching of menstruating women was
consideredtoxic, they were prohibited from cooking and from
takingcertain foods like pickle. These prohibitions are more in
therural areas than in the urban areas.Theywere also not allowedto
participate in religious activities or to contact religiousarticles
[21]. Menstruating girls are also not allowed to bathand wash hair,
as it is believed to impede blood flow.
3. Types of Absorbents Usedduring Menstruation
The preference of sanitary protection material is basedon
personal choice, cultural acceptability, economic status,and
availability in local market. Along with basic sanita-tion
facilities, one should be also provided with soap andmenstrual
absorbents to manage menstruation hygiene. Thechoice of absorbents
varies among rural and urban womenand girls. In rural areas, the
most preferred absorbents arereusable cloth pads and in urban areas
women prefer touse commercial sanitary pads. Chlorine-bleached
Kraft orsulphate pulp is used by manufacturers to produce fluff
pulpas absorbent used to make disposable sanitary
products.Nowadays, many deodorised and non-deodorised
sanitaryproducts are available in the market made of synthetic
fibrerayon. These deodorised products contain chemicals
likeorganochlorines which have antibacterial activity. Due totheir
chemical composition, these products when buried inthe soil they
kill the soils microflora and delay the processof decomposition
[22]. Different menstrual products used bywomen/girls are discussed
below (Figure 1).
3.1. Reusable and Washable Cloth Pads. They may be sus-tainable
sanitary option but must be hygienically washed anddried in the
sunlight. The sun’s heat is a natural sterilizer anddrying the
cloths/cloth pads under it sterilizes them for futureuse. These
cloth pads are reusable so they are cost-effective,easily
available, and ecofriendly. They also need to be storedin a clean
dry place for reuse to avoid contamination.
3.2. Commercial Sanitary Pads. They are easily available atmany
stores, chemist shops, or online. They are expen-sive, compared to
cloth pads, nonreusable, and not veryenvironment-friendly.The
cotton used in their making is not100% natural and may contain
pesticides.
3.3. Tampons. They are the type of absorbent that
providesinternal protection.They are kind of plug of softmaterial
(cot-ton) which is inserted into the vagina to absorb
themenstrual
-
Journal of Environmental and Public Health 3
(a) (b) (c)
(d) (e) (f)
(g) (h) (i)
Figure 1: Types of sanitary products used by women during
menstruation are (a) reusable cloth pads
(https://www.etsy.com/market/clothmenstrual pads); (b) commercial
sanitary pads
(http://topyaps.com/things-girl-must-know-about-sanitary-pads); (c)
tampons (http://www.womensvoices.org/tag/tampons/); (d) pads made
from banana fibre (https://saathipads.com/); (e) sea sponges used
as sanitary
material(https://www.pinterest.com/pin/194640015120225878/); (f)
pads made up of water hyacinth
(https://www.ecouterre.com/jani-a-biodegrada-ble-sanitary-napkin-made-from-water-hyacinth/);
(g) menstrual cup
(http://rubycup.com/blog/how-to-clean-the-suction-holes-of-your-menstrual-cup/);
(h) pads made from wool
(https://www.pinterest.com/pin/198088083583361670/); (i) reusable
tampons
(http://natural-parentsnetwork.com/reusable-menstrual-products/).
flow before it leaves the body. They are expensive, not
easilydegradable in nature and, hence, not very
environmentalfriendly. Nowadays, sea sponge tampons are available
in themarket which are a natural alternative to synthetic
tampons.
3.4. Reusable Tampons. These are washable tampons madeup of
natural materials like bamboo, wool, cotton, or hemp.They are also
knitted or crocheted using the natural absorbentmaterial like
cotton or wool. They are inserted into thevagina to absorb
menstrual flow same as the disposable tam-pons.
3.5. Menstrual Cups. Theymay be a new technology for poorwomen
and girls and an alternative to sanitary pads andtampons. They are
like cups made of medical grade siliconerubber which makes the cup
easy to fold and get insertedinto the vagina to collect menstrual
blood. They can beworn up to 6–12 hours depending upon the amount
ofmenstrual flow, so it needs to be removed and emptied
lessfrequently. They are reusable and environment-friendly.
Itoffers sustainable, practical, and cost-effective
alternativewhere sanitation conditions are not good.
3.6. Bamboo Fibre Pads. Instead of wood pulp, bamboopulp is used
as an absorbing material in these sanitarypads. It has more
absorbing capacity and is safer to use.They are affordable, easily
decomposed, and environment-friendly padswhich also possess
antibacterial properties.Thisprovides infection and irritation-free
menstruation. Also,bamboo charcoal pads are available in the market
withadvantage that blood stains are not clearly visible and are
alsoreusable in nature.
3.7. Banana Fibre Pads. Nowadays, low-cost sanitary padsfor
rural womenmade fromwaste banana tree fibre were soldunder trade
name “Saathi” in India. They are environment-friendly and decompose
within six months after use.Besides these products, women in the
remote rural areasalso use natural materials like cow dung, leaves,
and
mud(https://sswm.info/category/background/background/back-ground/health-and-hygiene-issues/menstrual-hygiene-man-agement).
3.8. Water Hyacinth Pads. Menstrual pads manufacturedusing water
hyacinth is sold under trade name “Jani.” They
https://www.etsy.com/market/cloth_menstrual_padshttps://www.etsy.com/market/cloth_menstrual_padshttp://topyaps.com/things-girl-must-know-about-sanitary-padshttp://www.womensvoices.org/tag/tampons/http://www.womensvoices.org/tag/tampons/https://saathipads.com/https://www.pinterest.com/pin/194640015120225878/https://www.ecouterre.com/jani-a-biodegradable-sanitary-napkin-made-from-water-hyacinth/https://www.ecouterre.com/jani-a-biodegradable-sanitary-napkin-made-from-water-hyacinth/http://rubycup.com/blog/how-to-clean-the-suction-holes-of-your-menstrual-cup/http://rubycup.com/blog/how-to-clean-the-suction-holes-of-your-menstrual-cup/https://www.pinterest.com/pin/198088083583361670/http://naturalparentsnetwork.com/reusable-menstrual-products/http://naturalparentsnetwork.com/reusable-menstrual-products/https://sswm.info/category/background/background/background/health-and-hygiene-issues/menstrual-hygiene-managementhttps://sswm.info/category/background/background/background/health-and-hygiene-issues/menstrual-hygiene-managementhttps://sswm.info/category/background/background/background/health-and-hygiene-issues/menstrual-hygiene-management
-
4 Journal of Environmental and Public Health
are cost-effective, easily biodegradable, and ecofriendly
innature.
4. Menstrual Waste Disposal Techniques Usedby Women
Appropriate disposal of used menstrual material is stilllacking
in many countries of the world. Most of the coun-tries have
developed techniques to manage their fecal andurinary wastes but,
because of lack ofmenstrualmanagementpractices in the world, most
of the women dispose of theirsanitary pads or other menstrual
articles into domestic solidwastes or garbage bins that ultimately
become a part of solidwastes. Toilet facilities in India lack bins
for the disposal ofsanitary pads and hand washing facilities for
menstruatingwomen to handle menstrual hygiene. In urban areas,
wheremodern disposable menstrual products are used they disposeof
them by flushing in toilets and throwing in dustbins orthrough
solid waste management [23], but, in rural areas,there are many
options for disposing menstrual waste suchas by burying, burning,
and throwing in garbage or in pitlatrines. In rural areas, mostly
women use reusable and non-commercial sanitary materials like
reusable pads or cloths.Thus, they generate lesser amount of
menstrual waste ascompared to women in urban areas who rely on
commercialdisposable pads. The menstrual material was disposed
ofaccording to the type of product used, cultural beliefs,
andlocation of disposal. In slum areas, women dispose
theirmenstrual waste into pit latrines as burning and burial
weredifficult due to limited privacy space [24]. The reason
behindthat is it was seen by men or used in witchcraft.
In schools, due to lack of sanitary facilities, girls throwtheir
pads in toilets. In some cases, girls threw away their
usedmenstrual clothes without washing them. Also many werereported
being absent from school due to lack of disposalsystem, broken
lock/doors of toilets, lack of water tap, bucket,and poor water
supply [25, 26]. In some schools, incineratorsor “feminine hygiene
bins” are used for disposing menstrualwaste material but due to
shyness or fear of being seen byothers they refrained from using it
[27]. The behavior ofwomen regarding disposal is different when
being at homeand away from home. At home, they dispose the waste
bywrapping and throwing in the dustbin along with otherdomestic
waste. As mentioned above, the disposing habitschange according to
the place. In public places, prior tohaving knowledge about the
consequences of flushing thepads, they flush them in the toilets or
wrap and throw themin the dustbins. Where dustbins are not placed
they leavethe soiled pads wrapped or unwrapped in the toilet
corners.This makes the toilets dirty, breeding place for flies
andmosquitoes, and also unhygienic for other toilet users
andcleaners. In many cities, the persons who manage the
publictoilets always complain of blockage of sewage system
becauseof flushing of sanitary pads or rags in the toilet.
5. Consequences of Menstrual Waste Disposal
As sanitation systems were designed with urine and feces inmind,
they are unable to cope with the menstrual absorption
materials.These absorptionmaterials clog the sewer pipelinesas
they are unable to pass through and cause the systembackflow [28].
Materials like tampons, cotton wool, toiletpaper, and other organic
materials used for menstrual man-agement might be decomposed in pit
latrines/landfills exceptthe plastic inlay of the commercial
sanitary pads. Sanitarynapkins might decompose over a period of
about one yearexcept its plastic lining in on-site sanitation
[29].
In rural areas, pit latrines once full they were coveredwith
soil and new pit was dug but due to space limitationsthis was not
practiced in urban areas [30]. It was reportedthat some women and
girls wrap their used menstrual clothsand packs in polythene bags
before disposing in pit latrineswhich prevents them
fromdecomposition.Nowadays,mostlywomen/girls prefer commercial
sanitary pads and tamponswhich are made up of superabsorptive
materials like poly-acrylate. These pads and tampons when flushed
in the toiletsthey get saturated with liquid and swell up, thus
resulting insewage backflow, a serious health hazard.The adhesive
wingsand the perforated plastic layers in the commercial
sanitarynapkins are not easily biodegradable. The sewage
blockageswere mostly due to accumulation of excessive quantity
ofsolid waste or sand which results in hardening of the sludgein
the pits. Blockage of sewage system is a global problem andmajor
contributing factor is flushing of menstrual productsin toilets.
Deodorised sanitary products used by women/girlscontain chemicals
used in bleaching such as organochlorineswhich when buried in the
soil disturb the soil microflora anddecomposition takes time
[22].
People living alongside river banks throw menstrualwaste into
water bodies which contaminate them. Thesematerials soaked with
blood were breeding places for germsand pathogenic microbes [31].
Sanitary products soaked withblood of an infected women/girl may
contain hepatitis andHIV viruses which retain their infectivity in
soil and liveup to six months in soil. The clogged drainage with
napkinshas to be unblocked and cleaned manually by
conservancyworkers with their bare hands without proper protection
andtools. This exposes the workers to harmful chemicals
andpathogens. Incineration is a better technique to dispose
ofmenstrual waste but burning of pads releases harmful gassesthat
effects health and environment. Burning of inorganicmaterial at low
temperature releases dioxins which are toxicand carcinogenic in
nature.
6. Role of Men/Boys towards MenstrualHygiene Management
One of the main reasons why menstruation is a tabooand
menstruation hygiene is neglected is gender inequality.Unequal
rights given to men and women result in women’svoices being ignored
within households and communitiesand in development programmes. Due
to cultural norms andstigmas, menstruating women are not allowed to
use waterand sanitation facilities and in some cases even
excludedfrom home as menstruation is considered impure [32,
33].Therefore, comprehensive programmes that engage bothmen and
women should be organized related to menstrualhygiene.
-
Journal of Environmental and Public Health 5
Men can support and influence women and girls in man-aging
menstruation in households, schools, work, and com-munity through
many roles as husbands, fathers, brothers,students, teachers,
colleagues, leaders, and policymakers. Byreviewing literature, it
was found that at household level mendo not support women regarding
menstruation hygiene andnever have they discussed menstrual issues
with their wivesand daughters. As they are decision-makers at
householdlevel, in many cases they do not give money to buy
menstrualproducts such as commercial sanitary pads, tampons,
andmenstrual cups as they consider it money wastage. So womenhave
to rely on cheap reusable cloth pads which they have towash, dry,
and use again. In other cases, due to low familyincome, men
hesitate to give money for such costly products.So, in both cases,
women have to compromise with theirmenstrual needs and personal
hygiene [34].
Decisions related to constructing toilets in houses are
alsotaken by male members. So it is a big barrier in
menstrualhygiene as women find it difficult in cleaning and
changingmenstrual materials in privacy [35]. Women and girls
whohave toilets at home feel shy and embarrassed as the drainthat
leads out is not covered and there is a chance of seeingblood
flowing in drain by others [36, 37]. In some reports,it was found
that parents did not allow boys to discuss suchtopic as they were
not important for their future, so the boysreceived information
about menstruation from friends andInternet which is inaccurate and
incomplete. In some places,like in Nepal, menstruating women have
to live separately ina “chhaupadi” during menstruation outside the
house. Thiscultural norm is supported by both men and women
makingit difficult to survive for a menstruating women/girl
duringwinters [38]. They also have to face many challenges living
inchhaupadi’s such as getting bitten by snakes, fires, and
rapes.
Most men do not know about the menstruation andphysiological
changes in women during menstruation andmenstrual cycle, so it is
difficult to change their perceptionregarding menstruation and
menstrual hygiene. Due tounwillingness, myths, prejudices, and
misconceptions, it isdifficult to talk about menstruation with men
and boys.But by engaging them into group discussions and
regularcommunity meetings, we can change their perception andmake
them aware about their role regarding menstrualhygiene management.
In India, a man named “ArunachalamMuruganantham” known as “India’s
Menstrual Man” devel-ops an inexpensive and
environment-friendlymachinewhichproduces semibiodegradable sanitary
pads. Men can helpwomen and girls by constructing toilets,
incinerators, andlatrines with chutes at homes and schools and at
communitylevel. At household level, they help by providing toilet
facili-ties with privacy, water, and soap and by giving them
moneyfor menstrual products. As the decision-making power isin
men’s hand, making household budgeting for sanitarymaterials
supports and empowers women by allowing themto move freely with
lower risk of stains. Men who are inpolitics support menstrual
hygiene management by makinggirls/women friendly policies, by
providing sanitarymaterialsfree of cost or at affordable prices, by
providing water andsanitation in their areas, and by conducting
seminars andworkshops in rural areas.
7. Role of Teachers in Creating Awarenessregarding Menstruation
and MenstrualWaste Management
In schools, teachers can make the school environmentgirl/women
friendly to manage menstruation with dignity.Sex education in
schools helps adolescents to discover theirsexual identity, to
protect themselves from sexual abuse,unwanted pregnancies, and
sexually transmitted diseases,and to know physiological changes
occurring in the body andhow to take care of personal hygiene [39].
In most of thecases, teacher’s attitude is not good and supportive
towardsmenstruating girls in schools. Different views of
parents,teachers, and society affect sex education being taught
inschools and colleges. Cultural, religious, and social
barriersalso create hindrance in the path of sex education
[40].
Our education sector plays an important role in child’sgrowth
and development by allowing them to respond tochanges and
challenges they are facing in day-to-day life [41].But many times
it avoids issues related to the menstruationand menstrual hygiene
management by considering it one’spersonal matter and should be
discussed within the house.Menstruation is a silent issue in girl’s
life which is furtheraffected by teacher’s attitude, school
environment, and infras-tructure. Because of this. many girls
remain absent fromschools during this time. Sex education is often
neglectedfrom the school curriculum which negatively impacts
thestudent’s life. They get information about puberty,
sexualintercourse, menstruation, and other physiological changesin
one’s body from books, friends, and Internet whichmay beincomplete
or inaccurate.Due to lack of knowledge and socialinteraction,
teasing and taunting with hurtful nicknames arecommon in schools.
This makes it difficult for a girl studentto survive in this
environment, so they remain absent fromschool.
In many schools, both male and female teachers arenot ready to
discuss menstruation and menstrual hygienemanagement with students.
The female teachers are also notavailable in many schools. Teachers
often skip such topics inbooks as they do not want any open
discussion in the classor to escape from the questions asked by
students. Teachersalso feel shy and embarrassed to discuss such
topics in classdue to language barrier [42]. In most schools,
English is not acompulsory subject so teachers have to discuss them
in locallanguage and using vernacular words in front of students
isan embarrassing thing. Due to unsupportive environment inthe
schools, it was also found that some girls hesitate to standto
answer teacher’s questions in fear of leakage or smell andalso
hesitate to write on blackboard in fear of any menstrualaccident
and blood stains on clothes seeing by others. In somereported
cases, parents do not allow girls to go to schoolsupon reaching
puberty in fear of sexual harassment by boysand male teachers in
schools [43].
To overcome these issues, male teachers and employeesin the
schools and institutes should be well educated andconfident
regarding menstruation and menstrual hygienemanagement so that they
support girls/women by providingsafe environment and privacy. A
committee of teachersincluding both male and females should be made
in the
-
6 Journal of Environmental and Public Health
schools to collect funds for providing sanitary napkins,
soaps,water, and toilet facilities in schools so that girls
managetheir menstruation with ease and safety. Committee shouldalso
provide dustbins for menstrual waste disposal. Separatetoilets for
girls and boys with proper doors and locks shouldbe built in the
schools. Teachers should educate girls aboutmenstrual health
management and its link to their health.They should also make girl
students aware of how to disposeof usedmenstrual products at home
and in schools and aboutthe consequences of throwing them in open
or flushing themin toilets. Open discussions on puberty, sex
education,menstruation, and so forth should be organized by
schoolsin every class to make students aware. This will solve
theirunsolved queries by providing them correct knowledge,promote
social interaction, and also develop a trust relation-ship with
fellow friends and teachers. School-level healthpolicies should
bemade by schoolmanagement committee topromote and educate students
regarding health and safety, toensure adequate water and sanitation
facilities, and to protectgirl students and staff from bullying and
sexual harass-ment.
Some Case Studies
Case 1. Recently in a school in Tamil Nadu, a 12-year-oldschool
girl of 7th class committed suicide after
menstrualshaming.According to hermother, her periods started
duringa class where she was given a duster cloth to be used as
apad. Then reportedly, she was forced to leave the classroomwhen
her clothes got stained by blood. The next day shedid not bear the
humiliation and committed suicide due toharassing and torturing by
the teacher in the class as writtenin the suicide note (source:
http://www.bbc.com/news/world-asia-india-41107982).
Case 2. Around 70 girls of the Kasturba School hostelwere
ordered to remove their clothes by the hostel wardento check for
menstrual blood after she found blood stains inthe washroom.This
shameful act happened inMuzaffarnagar(UP) in March 2017 (source:
https://timesofindia.indiatimes.com/city/lucknow/girl-students-told-to-strip-to-check-for-menstrual-blood-up-government-orders-probe/articleshow/57940071.cms).
8. Strategies for the Management ofMenstrual Waste
(1) Disposal of menstrual waste is of major concern as itaffects
health and environment. There is a need foreffective menstrual
materials which needs less andcost-effective management.
(2) Companies dealing with manufacturing of sanitarypads or
other articles should disclose the informationon the pads regarding
the chemical composition ofthe pads so that appropriate
technologies could beused for their disposal and treatment.
(3) Environment-friendly chemicals should be used
bymanufacturers of sanitary products to stop soil and
Figure 2: Sanitary napkin vending machine. Source:
https://timesofindia.indiatimes.com/city/pune/sanitary-napkin-vending-machines/articleshow/57824878.cms.
water pollution and to fasten the decompositionprocess.
(4) Guidance regarding menstrual management to ado-lescent girls
and women is a much needed step.Menstrual hygienemanagement should
be an integralpart of education curriculum.
(5) Distribution of menstrual products should be freeof cost in
schools and educational institutes [44].Recently, instead of
subsidizing the menstrual pads,Indian government has imposed 12%
GST on themwhich is not verywomen friendly (source:
http://www.livemint.com/Industry/2Y4RRe0XaJmVduujmsDdXL/GST-rate-on-sanitary-napkins-fixed-at-12.html).
(6) The toilets must be designed and built to be girl/women
friendly [45]. In Kerala, some schools haveinstalled sanitary
napkin vending machines in toiletswhich are semiautomatic and
operate by inserting acoin in it. It contains 30–50 sanitary
napkins to meetthe emergency needs of the girls/women in
schools(Figure 2).
(7) There should be a separate collection system for
themenstrual wastes without affecting the privacy anddignity of
women. Specific sanitary dispensers tocollect menstrual waste
should be installed.
(8) There should be sufficient space for washing,
cleaningprivate parts and hands and for changing or dealingwith
stained clothes. To fulfil these requirements,there must be water
availability, toilet paper, dustbin,and a sink to wash menstrual
products.
(9) Dustbins should be covered by lid and emptied fromtime to
time to keep the toilets clean from flies,mosquitoes, and bad
odour.
(10) Covered containers and dustbins have advantage ofhiding the
waste being seen by others. They areinstalled in a place that
offers privacy [21].
(11) Gloves and proper safety tools should be provided tothe
cleaners so that they are not exposed to patho-genic organisms and
harmful gasses.
(12) Government should introduce new rules for the safedisposal
and treatment of menstrual wastes as they
http://www.bbc.com/news/world-asia-india-41107982http://www.bbc.com/news/world-asia-india-41107982https://timesofindia.indiatimes.com/city/lucknow/girl-students-told-to-strip-to-check-for-menstrual-blood-up-government-orders-probe/articleshow/57940071.cmshttps://timesofindia.indiatimes.com/city/lucknow/girl-students-told-to-strip-to-check-for-menstrual-blood-up-government-orders-probe/articleshow/57940071.cmshttps://timesofindia.indiatimes.com/city/lucknow/girl-students-told-to-strip-to-check-for-menstrual-blood-up-government-orders-probe/articleshow/57940071.cmshttps://timesofindia.indiatimes.com/city/lucknow/girl-students-told-to-strip-to-check-for-menstrual-blood-up-government-orders-probe/articleshow/57940071.cmshttps://timesofindia.indiatimes.com/city/pune/sanitary-napkin-vending-machines/articleshow/57824878.cmshttps://timesofindia.indiatimes.com/city/pune/sanitary-napkin-vending-machines/articleshow/57824878.cmshttps://timesofindia.indiatimes.com/city/pune/sanitary-napkin-vending-machines/articleshow/57824878.cmshttp://www.livemint.com/Industry/2Y4RRe0XaJmVduujmsDdXL/GST-rate-on-sanitary-napkins-fixed-at-12.htmlhttp://www.livemint.com/Industry/2Y4RRe0XaJmVduujmsDdXL/GST-rate-on-sanitary-napkins-fixed-at-12.htmlhttp://www.livemint.com/Industry/2Y4RRe0XaJmVduujmsDdXL/GST-rate-on-sanitary-napkins-fixed-at-12.html
-
Journal of Environmental and Public Health 7
Figure 3: Incinerator installed in the toilet for easy sanitary
productsdisposal. Source:
http://www.vendingbiz.in/sanitary-napkin-incin-erators-napkinci-maxi-1902444.html.
have made for solid or biomedical wastes. Appropri-ate policy
and legal framework is necessary for themanagement of menstrual
wastes.
(13) Government and non-government organizationsshould come
forward for making the people awareof management of menstrual
wastes. Governmentshould give the funds to the Municipal
Corporationor NGOs for the construction of women
friendlytoilets.
(14) Health implications of menstrual wastes should beproperly
investigated. Financial support should begiven to the institutions
to carry out the research inthe management of menstrual wastes.
(15) Scientific research should be encouraged for the
mostsuitable techniques of disposal of sanitary pads orother
menstrual products.
(16) Allocation of budget in schools to support menstrualhygiene
management studies should be conducted.
(17) Collaborative efforts (trash bins) should be made.(18)
Incinerators are a better option for disposal but
should be operated in a controlled environment sothat harmful
gasses emitted will not harm larger area.
9. Better Ways/Ideas of DisposingMenstrual Wastes
9.1. Incinerators. If incinerators are used according
toecofriendly guidelines they create less pollution.They shouldbe
operated at certain specific temperature around 800∘C sothat they
emit less harmful gasses.They should be installed inschools,
institutions, and slum areas and at community level(Figure 3).
9.2. Latrines with Chutes. These are special kind of toilets
inwhich a shoulder level Chute was made in the usual deep pit.A
chemical agent was added to the pit five times in a monthto enhance
the decomposition process of used napkins.
9.3. Reusable Cloth Pads. Using these reusable cloth padsis a
better option as they have less chemical and plastic
content. So they are easily decomposable as compared toother
commercial products.
9.4. Biodegradable Products. Commercial sanitary
productmanufacturing companies must manufacture products hav-ing
lesser chemical and plastic content. Pads made frombamboo fibre,
banana fibre, water hyacinth, and sea spongesshould be
encouraged.
9.5. Clay or Cemented Incinerators. Clay and cement
incin-erators used in Gujrat villages by “Vatsalya Foundation”are a
welcomed step in menstrual hygiene management. Alady named “Swati”
designed this incinerator and namedit “Ashudhinashak” which burns
many sanitary napkins ata time without creating any smoke. This
ecofriendly andcheap innovation is appreciated by rural women who
founddifficulty in disposing them (Figure 4).
9.6. Better Disposal Techniques. Special covered bins shouldbe
installed to handle menstrual waste. Disposal bags shouldbe
provided by manufacturing companies with color indica-tion for
disposing these products.These bags should be freelydistributed
among schools and institutions. Menstrual wasteshould not be
disposed of along with domestic waste. Padsshould be properly
wrapped in newspaper and then thrownin the dustbins. By this it
should also be safe for rag pickersas it does not expose them to
any disease-causing pathogens.
10. Conclusions
Menstrual hygiene should be promoted by implementinga course on
menstruation and menstrual hygiene manage-ment. Teachers should be
educated and trained to impartknowledge about menstruation and
menstrual hygiene man-agement among students. Social and electronic
media alsoplay an important role to make the girls and women
awareabout the latest menstrual products, different
manufacturers,government policies, and so forth. Subsidies should
begiven on menstrual products so that every girl/women canafford
them easily. Non-government organizations shouldcome forward to
educate rural people about menstruation,menstrual hygiene
management, importance of toilets athomes, hand washing, diseases
related to reproductive tractdue to poor hygiene, and so forth.
Emphases should be givenon the use of reusable sanitary or cloth
pads to overcome theproblem of disposal. Girls and women should be
aware of theconsequences of disposing used menstrual products in
openor flushing them in toilets. Dustbins with proper lids shouldbe
placed in the toilets. If possible, incinerators should beinstalled
at homes, schools, and community levels.This studyreveals that lack
of privacy is a major concern both in house-hold and in schools.
Also, ignorance, misconceptions, unsafepractices, and illiteracy of
the mother and child regardingmenstruation are the root causes of
many problems. So, thereis a big need to encourage adolescents at
school levels topractice safe and hygienic behaviors.
Conflicts of Interest
The authors of this paper have no conflicts of interest.
http://www.vendingbiz.in/sanitary-napkin-incinerators-napkinci-maxi-1902444.htmlhttp://www.vendingbiz.in/sanitary-napkin-incinerators-napkinci-maxi-1902444.html
-
8 Journal of Environmental and Public Health
(a) (b) (c)
Figure 4: Incinerators used to dispose of menstrual waste in
rural areas of India: (a) clay incinerator
(http://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkins);
(b) mud incinerator
(https://www.thebetterindia.com/87876/master-art-deal-with-menstrual-waste/);
(c) cement incinerator
(http://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkins).
Acknowledgments
The authors are highly thankful to University Grants Com-mission
for providing financial assistance under UPE (Uni-versity with
Potential for Excellence) scheme and GuruNanak Dev University,
Amritsar, for providing necessaryinfrastructure to carry out the
research work.
References
[1] World Health Organization, “Programming for adolescenthealth
and development,” WHO Technical Report Series No.886, vol. 2, World
Health Organization, 1996.
[2] S. B. Thakre, S. S. Thakre, M. Reddy, N. Rathi, K. Pathak,
andS. Ughade, “Menstrual hygiene: knowledge and practice
amongadolescent school girls of Saoner, Nagpur District,” Journal
ofClinical and Diagnostic Research, vol. 5, no. 5, pp.
1027–1033,2011.
[3] A. Bagga and S. Kulkarni, “Age atmenarche and secular trend
inMaharashtrian (Indian) girls,” Acta Biologica Szegediensis,
vol.44, no. 1-4, pp. 53–57, 2000.
[4] A. Diaz, M. R. Laufer, and L. L. Breech, “Menstruation in
girlsand adolescents: Using the menstrual cycle as a vital sign,”
Ped-iatrics, vol. 118, no. 5, pp. 2245–2250, 2006.
[5] S. Nagar and K. R. Aimol, “Knowledge of Adolescent
GirlsRegarding Menstruation in Tribal Areas of Meghalaya,”
Studiesof Tribes and Tribals, vol. 8, no. 1, pp. 27–30, 2017.
[6] A. Dasgupta and M. Sarkar, “Menstrual hygiene: how
hygienicis the adolescent girl?” Indian Journal of Community
Medicine,vol. 33, no. 2, pp. 77–80, 2008.
[7] I. Swenson and B. Havens, “Menarche and Menstruation:
AReview of the Literature,” Journal of Community Health
Nursing,vol. 4, no. 4, pp. 199–210, 1987.
[8] D. Sapkota, D. Sharma, H. P. Pokharel, S. S. Budhathoki, and
V.K. Khanal, “Knowledge and practices regarding menstruation
among school going adolescents of rural Nepal,” Journal
ofKathmanduMedical College, vol. 2, No. 3, no. 5, pp. 117–121,
2014.
[9] A. Khanna, R. S. Goyal, and R. Bhawsar, “Menstrual
practicesand reproductive problems: a study of adolescent girls
inRajasthan,” Journal of Health Management, vol. 7, no. 1, pp.
91–107, 2005.
[10] K. A. Narayan, D. K Srinivastava, P. J. Pelto, and S.
Veerapm-mal, “Puberty Rituals, Reproductive Knowledge and Health
ofAdolescent Schoolgirls in South India,” Asia-Pacific
PopulationJournal, vol. 16, pp. 225–238, 2001.
[11] T. Rajaretnam and J. S. Hallad, “Menarche, menstrual
problemsand reproductive tract infections among adolescents in the
ruraland urban areas of northern Karnataka in India,” in
Proceedingsof the European population Conference, vol. 4, pp. 1–4,
ViennaAustria, 2010.
[12] A. B. Mudey, N. Kesharwani, G. A. Mudey, and R. C. Goyal,
“ACross-sectional Study on Awareness Regarding Safe and Hygi-enic
Practices amongst School Going Adolescent Girls in RuralArea of
Wardha District, India,” Global Journal of Health Sci-ence, vol. 2,
no. 2, pp. 225–231, 2010.
[13] O. U. Umeora and V. E. Egwuatu, “Menstruation in rural
Igbowomen of south east Nigeria: attitudes, beliefs and
practices.,”African Journal of Reproductive Health, vol. 12, no. 1,
pp. 109–115, 2008.
[14] U. Aniebue, P. Aniebue, and T. Nwankwo, “The impact of
pre-menarcheal training on menstrual practices and hygiene
ofNigerian school girls,” Pan African Medical Journal, vol. 2,
no.9, 2010.
[15] K.DrakshayaniDevi and P. Venkata Ramaiah, “A study
onmen-strual hygiene among rural adolescent girls.,” Indian Journal
ofMedical Sciences, vol. 48, no. 6, pp. 139–143, 1994.
[16] K. Jogdand and P. A. Yerpude, “Community based study
onmenstrual hygiene among adolescent girls,” Indian Journal
ofMaternal and Child Health, vol. 13, no. 3, pp. 1–6, 2011.
http://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkinshttp://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkinshttps://www.thebetterindia.com/87876/master-art-deal-with-menstrual-waste/https://www.thebetterindia.com/87876/master-art-deal-with-menstrual-waste/http://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkinshttp://www.ecoideaz.com/innovative-green-ideas/ashudhinashak-clay-incinerators-for-sanitary-napkins
-
Journal of Environmental and Public Health 9
[17] R. Dhingra, A. Kumar, and M. Kour, “Knowledge and
practicesrelated tomenstruation among Tribal (Gujjar) adolescent
girls,”Studies on Ethno-Medicine, vol. 3, no. 1, pp. 43–48,
2009.
[18] M. Sommer, M. Kjellén, and C. Pensulo, “Girls’ and
women’sunmet needs for menstrual hygiene management (MHM):
Theinteractions between MHM and sanitation systems in low-income
countries,” Journal of Water Sanitation and Hygiene forDevelopment,
vol. 3, no. 3, pp. 283–297, 2013.
[19] D. S. Deo and C. H. Ghattargi, “Perceptions and
practicesregardingmenstruation: a comparative study in urban and
ruraladolescent girls,” Indian Journal of CommunityMedicine, vol.
30,pp. 33-34, 2005.
[20] M. Amann-Gainotti, “Sexual socialization during early
adoles-cence: the menarche.,” Adolescence, vol. 21, no. 83, pp.
703–710,1986.
[21] V. Tjon A Ten, “Menstrual Hygiene: A Neglected Condition
forthe Achievement of Several Millennium Development Goals,”Europe
External Policy Advisors, 2007.
[22] R. Kroesa,TheGreenpeace Guide to Paper, Greenpeace,
Vancou-ver, Canada, 1990.
[23] R. Ashley, D. Blackwood, N. Souter et al., “Sustainable
disposalof domestic sanitary waste,” Journal of Environmental
Engineer-ing, vol. 131, no. 2, pp. 206–215, 2005.
[24] S. Garg, N. Sharma, and R. Sahay, Socio-cultural Aspects
ofMen-struation in an Urban Slum in Delhi, Maulana Azad
MedicalCollege, New Delhi, India, 2001.
[25] T.Mahon andM. Fernandes, “Menstrual hygiene in South Asia:A
neglected issue for WASH (water, sanitation and
hygiene)programmes,” Gender and Development, vol. 18, no. 1, pp.
99–113, 2010.
[26] C. Jasper, T.-T. Le, and J. Bartram, “Water and sanitation
inschools: a systematic review of the health and educational
out-comes,” International Journal of Environmental Research
andPublic Health, vol. 9, no. 8, pp. 2772–2787, 2012.
[27] T. Crofts and J. Fisher, “Menstrual hygiene in Ugandan
schools:An investigation of low-cost sanitary pads,” Journal of
WaterSanitation and Hygiene for Development, vol. 2, no. 1, pp.
50–58,2012.
[28] S. Arthur, H. Crow, and L. Pedezert, Understanding
BlockageFormation in Sewer Systems A Case-By-Case Approach,
Herriot-Watt University, Edinburgh, Scotland, 2008.
[29] S. Bharadwaj and A. Patkar, Menstrual Hygiene and
Manage-ment in Developing Countries: Taking Stock, 2004.
[30] J. N. Bhagwan, D. Still, C. Buckley, and K. Foxon,
“Challengeswith up-scaling dry sanitation technologies,”Water
Science andTechnology, vol. 58, no. 1, pp. 21–27, 2008.
[31] D. Shoemaker, “Proper procedure for sanitary napkin
disposal,”Cleaning and Maintenance Management, vol. 45, no. 4, pp.
33–37, 2008.
[32] Water Aid, Is menstrual Hygiene and management an issue
forAdolescent Girls?” Water Aid in South Asia Publication,
2009.
[33] S. House, T.Mahon, and S. Cavill,A resource for
improvingmen-strual hygiene around the world, Menstrual Hygiene
Matters,Water Aid, London, UK, 2012.
[34] S. Piper-Pillitteri, School Menstrual Hygiene Management
inMalawi: More than Toilets, Water Aid, London, UK, 2011.
[35] K.O’Reilly andE. Louiss’, “The toilet tripod:Understanding
suc-cessful sanitation in rural India,”Health & Place, vol. 29,
pp. 43–51, 2014.
[36] Water for People,Menstrual Hygiene and Management: A
PilotStudy inWest Bengal, India,Water for People, Denver,
CO,USA,2008.
[37] K. T. Alexander, C. Oduor, E. Nyothach et al., “Water,
sanitationand hygiene conditions in kenyan rural schools: Are
schoolsmeeting the needs of menstruating girls?”Water
(Switzerland),vol. 6, no. 5, pp. 1453–1466, 2014.
[38] R. George, What Is Life like When Your Period Means You
AreShunned by Society? New Statesmen, 2014.
[39] D. B. Kirby, B. A. Laris, and L. A. Rolleri, “Sex and
HIVeducation programs: their impact on sexual behaviors of
youngpeople throughout the world,” Journal of Adolescent Health,
vol.40, no. 3, pp. 206–217, 2007.
[40] S. Pokharel, A. Kulczycki, and S. Shakya, “School-Based
SexEducation in Western Nepal: Uncomfortable for Both Teachersand
Students,” Reproductive Health Matters, vol. 14, no. 28,
pp.156–161, 2006.
[41] A. O. Fatusi and M. J. Hindin, “Adolescents and youth in
devel-oping countries: Health and development issues in
context,”Journal of Adolescence, vol. 33, no. 4, pp. 499–508,
2010.
[42] S. Bott, S. Jejeebhoy, I. Shah, and C. Puri, Towards
adulthood:Exploring the sexual and reproductive health of
adolescents inSouth Asia, Department of Reproductive Health and
Research,World Health Organization, 2003.
[43] J. D. G. Goldman, “Responding to parental objections to
schoolsexuality education: A selection of 12 objections,” Sex
Education:Sexuality, Society and Learning, vol. 8, no. 4, pp.
415–438, 2008.
[44] R. Garg, S. Goyal, and S. Gupta, “India moves towards
men-strual hygiene: Subsidized sanitary napkins for rural
adolescentgirls - Issues and challenges,”Maternal andChildHealth
Journal,vol. 16, no. 4, pp. 767–774, 2012.
[45] M. Kjellén, C. Pensulo, P. Nordqvist, and M. Fogde,
“GlobalReview of Sanitation System Trends and Interactions
withMenstrual Management Practices,” Report for the
MenstrualManagement and Sanitation Systems Project, Stockholm
Envi-ronment Institute, Stockholm, Sweden, 2011.
-
Stem Cells International
Hindawiwww.hindawi.com Volume 2018
Hindawiwww.hindawi.com Volume 2018
MEDIATORSINFLAMMATION
of
EndocrinologyInternational Journal of
Hindawiwww.hindawi.com Volume 2018
Hindawiwww.hindawi.com Volume 2018
Disease Markers
Hindawiwww.hindawi.com Volume 2018
BioMed Research International
OncologyJournal of
Hindawiwww.hindawi.com Volume 2013
Hindawiwww.hindawi.com Volume 2018
Oxidative Medicine and Cellular Longevity
Hindawiwww.hindawi.com Volume 2018
PPAR Research
Hindawi Publishing Corporation http://www.hindawi.com Volume
2013Hindawiwww.hindawi.com
The Scientific World Journal
Volume 2018
Immunology ResearchHindawiwww.hindawi.com Volume 2018
Journal of
ObesityJournal of
Hindawiwww.hindawi.com Volume 2018
Hindawiwww.hindawi.com Volume 2018
Computational and Mathematical Methods in Medicine
Hindawiwww.hindawi.com Volume 2018
Behavioural Neurology
OphthalmologyJournal of
Hindawiwww.hindawi.com Volume 2018
Diabetes ResearchJournal of
Hindawiwww.hindawi.com Volume 2018
Hindawiwww.hindawi.com Volume 2018
Research and TreatmentAIDS
Hindawiwww.hindawi.com Volume 2018
Gastroenterology Research and Practice
Hindawiwww.hindawi.com Volume 2018
Parkinson’s Disease
Evidence-Based Complementary andAlternative Medicine
Volume 2018Hindawiwww.hindawi.com
Submit your manuscripts atwww.hindawi.com
https://www.hindawi.com/journals/sci/https://www.hindawi.com/journals/mi/https://www.hindawi.com/journals/ije/https://www.hindawi.com/journals/dm/https://www.hindawi.com/journals/bmri/https://www.hindawi.com/journals/jo/https://www.hindawi.com/journals/omcl/https://www.hindawi.com/journals/ppar/https://www.hindawi.com/journals/tswj/https://www.hindawi.com/journals/jir/https://www.hindawi.com/journals/jobe/https://www.hindawi.com/journals/cmmm/https://www.hindawi.com/journals/bn/https://www.hindawi.com/journals/joph/https://www.hindawi.com/journals/jdr/https://www.hindawi.com/journals/art/https://www.hindawi.com/journals/grp/https://www.hindawi.com/journals/pd/https://www.hindawi.com/journals/ecam/https://www.hindawi.com/https://www.hindawi.com/